Cost-effectiveness analysis of pulse oximetry screening for critical congenital heart defects following homebirth and early discharge

Abstract

Pulse oximetry (PO) screening is used to screen newborns for critical congenital heart defects (CCHD). Analyses performed in hospital settings suggest that PO screening is cost-effective. We assessed the costs and cost-effectiveness of PO screening in the Dutch perinatal care setting, with home births and early postnatal discharge, compared to a situation without PO screening. Data from a prospective accuracy study with 23,959 infants in the Netherlands were combined with a time and motion study and supplemented data. Costs and effects of the situations with and without PO screening were compared for a cohort of 100,000 newborns. Mean screening time per newborn was 4.9 min per measurement and 3.8 min for informing parents. The additional costs of screening were in total €14.71 per screened newborn (€11.00 personnel, €3.71 equipment costs). Total additional costs of screening and referral were €1,670,000 per 100,000 infants. This resulted in an incremental cost-effectiveness ratio of €139,000 per additional newborn with CCHD detected with PO, when compared to a situation without PO screening. A willingness-to-pay threshold of €20,000 per gained QALY for screening in the Netherlands makes the screening likely to be cost-effective.Conclusion: PO screening in the Dutch care setting is likely to be cost-effective. What is Known: • Pulse oximetry is increasingly implemented as a screening tool for critical congenital heart defects in newborns.• Previous studies suggest that the screening in cost-effective and in the USA a reduction in infant mortality from critical congenital heart defects was demonstrated. What is New: • This is the first cost-effectiveness analysis for pulse oximetry screening in a setting with screening after home births, with screening at two moments.• Costs of pulse oximetry screening in a setting with hospital and homebirth deliveries were €14.71 and is likely to be cost-effective accordint to Dutch standards.

The Methodological Quality and Challenges in Conducting Economic Evaluations of Newborn Screening: A Scoping Review

“…After duplicate removals, 716 articles were considered eligible for screening by title and abstract. After full-text screening, 35 articles were included for the final assessment (see Appendix C for the PRISMA flow diagram) [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 ]. No additional studies were found on the websites of the INAHTA HTA agencies.…”

Costos De Las Intervenciones Para El Diagnóstico Y Tratamiento De Anomalías Congénitas: Revisión De Alcance

“…Diversos fatores estão envolvidos na prevalência das AC, de um modo geral nesta amostra foram captadas maior quantitativo de publicações que abordaram as AC do sistema cardiovascular e respiratório (14,16,(19)(20)(21)(22)(23)(24)(25)28,29,33,38,(40)(41) . Esclarece-se que estas são complexas e demandam de exame de imagem para o diagnóstico, podendo impactar nas altas taxas de mortalidade (2) .…”

“…Quanto à população, o maior volume dos estudos incluiu crianças menores de um ano (13,15,17,18,23,25,29,33,(38)(39)(40)(41) . Cenário este que pode ser advindo do fato de as AC graves serem incompatíveis com a vida, assumindo papel crescentemente expressivo na morbimortalidade infantil, sobretudo no período neonatal (3) .…”

“…Houve destaque à produção de evidências científicas para o tratamento a ser realizado em ambiente hospitalar (14,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(27)(28)(29)30,31,(33)(34)(35)(36)(37)41) . Esta condição possivelmente está relacionada à necessidade dos cuidados intensivos, com o uso de recursos tecnológicos e de profissionais especializados para a manutenção da vida desse recém-nascido com AC, podendo relacionar-se também ao fato de demandarem por maior volume de recursos financeiros consequentes às taxas elevadas de rehospitalização e à mortalidade pósalta (43) .…”

“…Neste sentido, para que seja possível identificar as intervenções mais efetivas em relação ao custo e ao benefício dos tratamentos são desenvolvidas as pesquisas em economia em saúde, essas se propõem a avaliar as tecnologias e os desfechos clínicos associados à suas aplicações. Sendo assim, os estudos que relacionaram a triagem neonatal para AC de quadril, cardiopatias, desordens metabólicas e genéticas, e perda auditiva (13,15,26,29,32,(38)(39)(40)41) , apresentaram melhores resultados e menores custos, quando analisados a longo prazo, na vida criança. Espera-se que, crescentemente, um maior número de AC sejam passíveis de triagem no período neonatal, sobretudo, com o avanço na área de genomas (44) .…”